1. Findings from the 2016 Zambia Population-based HIV Impact Assessment (ZAMPHIA): HIV prevalence, incidence and progress towards the goals
Danielle T. Barradas, Ph.D.
U.S. Centers for Disease Control and Prevention – Lusaka, Zambia
25 July 2017

2. Disclosures and Disclaimers
I have no financial interests or any other conflicts of interest to disclose.
The findings and conclusions in this presentation are those of the authors and do not necessarily represent the views of the U.S. Centers for Disease Control and Prevention or other participating institutions.
These findings are preliminary and may be subject to change.

3. Zambia Sociodemographic Overview
2015 midyear population: 15.4 million
Average household size: 5.1 members
68% households have access to improved sources of drinking water; 40% have access to improved sanitation
Life expectancy at birth: 53 y
Total fertility: 5.3 births per woman
Under 5 mortality: 75 per 1000 births
Source: 2015 Selected Socio‐economic Indicators Report, CSO (pulls from 2015 Census projections [based on 2010 census] and ZDHS )
Source: 2015 Selected Socio‐economic Indicators Report

4. HIV/AIDS in Zambia
HIV/AIDS is the #1 health threat in Zambia and the leading cause of morbidity and mortality among adults (15-49 y)
In 2014, 13 out of 100 adults were living with HIV in Zambia
The lifetime risk of dying from HIV in Zambia is over 60%.
13 people living with HIV
87 people without HIV
Based on modeled estimates
Source: Zambia DHS,

5. of those with HIV know their status of those diagnosed are on ART
TARGETS FOR ENDING THE AIDS EPIDEMIC BY 2030
of those with HIV know their status
of those diagnosed are on ART
of those on ART are virally suppressed

6. What is ZAMPHIA? ZAMbia Population-based HIV Impact Assessment
A household-based national survey led by the Ministry of Health
Collection of behavioral and biomarker data with HIV testing with return of results and counseling
In collaboration with Central Statistical Office, Tropical Diseases Research Centre, University Teaching Hospital, University of Zambia, ICAP at Columbia University, and U.S. Centers for Disease Control and Prevention

7. ZAMPHIA Objectives
To estimate the following in a household-based, nationally representative sample of adults age 15-59:
HIV incidence at national level
Sub-national (provincial) prevalence of HIV viral load suppression (VLS)
Suppressed viral load = <1000 copies/mL, suggests successful treatment and lower chance of transmission
Measure progress toward meeting UNAIDS targets

8. Methods 12,310 eligible households in 511 enumeration areas
Behavioral and clinical information collected via adult and adolescent individual-level questionnaires
Demographic information collected via household questionnaire
Blood samples for HIV testing collected per national guidelines.

9. Methods
Confirmation of HIV-seropositive results using the Geenius supplemental assay
For this analysis, antiretroviral treatment is based on self-report.
Viral load and limiting antigen (LAg) avidity EIA testing were performed at a central lab on all HIV-seropositive samples. VLS was defined as HIV RNA <1000 copies/ml
Incidence was determined using results of LAg avidity and viral load testing
Statistical analyses completed using SAS v9.4 survey procedures

10. Scope of Presentation
Adult (15-59 y) and pediatric (0-14 y) HIV prevalence estimates
Adult HIV incidence estimates
Progress toward meeting the UNAIDS targets among adults
All at the national level

11. ZAMPHIA Response Rates
69% target overall adult response –
68% actual
77%*
Analytic sample comprised of 19,029 adults and 7,959 children provided interviews and blood samples (response rate: 68%).
Participation by eligible adults was higher for women than men (71% vs 63%, P<0.0001)
Overall Response Rate
*Adolescents 10-14

12. HIV Prevalence by Age and Sex: ZAMPHIA, 2016
Overall adult HIV prevalence: 12.0%
Adult prevalence among y = 12%. This corresponds to an estimated 960,000 persons living with HIV in Zambia. The prevalence was higher among females (14.6%) compared to males (9.3%).

13. Pediatric HIV Prevalence by Age and Sex: ZAMPHIA, 2016
Overall pediatric HIV prevalence: 0.9%
Add CI for overall estimate

14. HIV Incidence by Sex and Age: ZAMPHIA, 2016
Female
% [95% CI]
Male
Total
15–59 years
1.02%
[0.66, 1.37]
0.32%
[0.10, 0.54]
0.67%
[0.45, 0.88]
15–49 years
1.10%
[0.71, 1.48]
0.31%
[0.09, 0.54]
0.70%
[0.47, 0.93]
Reminder that survey was designed to estimate incidence at the national level only (hence the relatively wide CIs)
Add 2017 UNAIDS #s when available
UNAIDS (2015) Total (15–49 y): 0.85 [0.73, 0.99]

15. Viral Load Suppression among PLHIV by Sex and Age: ZAMPHIA, 2016*
Overall adult VLS: 59.1%
* Denominator is all PLHIV with viral load results.

16. Status of 90-90-90 Targets: ZAMPHIA, 2016
Conditional percentages shown here

17. Conclusions
Zambia is making progress toward the UNAIDS’ targets
Declining national HIV incidence; however, incidence among women remains unacceptably high
Further exploration of gaps in testing, ART, and viral load suppression is needed
Preliminary findings point toward the need to increase HIV testing, treatment, retention and adherence for both young men and young women.
Examples of policy and programmatic implications:
Self-testing, expanded hours, more (male) healthcare workers
Minimizing delays in ART initiation by maximizing the number of ART sites
Full implementation of Test and Start, PrEP
…Large undertaking… data has been made available in waves. The final dataset will include additional information including ARV biomarker, drug resistance, TB, and HIV knowledge/attitudes/beliefs data…

18. Acknowledgements ZAMPHIA participants
GRZ Ministry of Health (MOH): Crispin Moyo, Wezi Kaonga
Central Statistical Office (CSO): Nchimunya Nkombo
Tropical Diseases Research Centre (TDRC): Webster Kasongo
ICAP: Karampreet Sachathep, David Hoos, Kumbutso Dzekedzeke
CDC: Sundeep Gupta, Dan B. Williams, Bharat Parekh, Hetal Patel, Stanley Kamocha, Clement B. Ndongmo, Kathy Hageman, Margaret A. Riggs
ZAMPHIA study team